Abstract: Objective To explore the clinical efficacy of thoracoscopic combined with small incision in the treatment of severe multiple rib fractures. Methods From August 2015 to February 2018 ，A retrospective analysis of 32 patients with severe chest blunt trauma admitted to our department. All patients underwent thoracoscopic exploration within one week after injury and assisted with one or more A small incision of about 10cm ，using a nickeltitanium memory alloy rib embracing fixator to fix the ribs，remodeling the structure and stability of the chest wall，and recording data related to surgery. Results All 32 patients underwent successful operation. The average number of rib fixation was 5.6（4?11）. The average operation time was 126 min（86-180 min）. The average intraoperative blood loss was 130 mL（100-250 mL）. The average extubation time after operation was performed 3 d（2-5 d）， average postoperative hospital stay：10.5 d（6?18d），follow?up was followed up for a total of 6 months ， 2 patients with chronic chest pain，no death and other serious complications. Conclusion Thoracoscopy?assisted small incision is safe and effective in the treatment of severe multiple rib fractures. It can make internal fixation surgery more minimally invasive and promote rapid recovery.

Key words: severe rib fracture, thoracoscopic, rib internal fixation, flail chest

摘要： 目的 探讨胸腔镜探查联合小切口辅助对多发肋骨骨折内固定治疗的临床疗效。方法 回顾分析 2015 年 8 月至 2018 年 2 月间我科收治的严重胸部钝性伤行手术内固定病人共32 例，所有患者均于伤后一周内在胸腔镜下探查，并辅助予8 cm 左右的小切口，选用镍钛记忆合金肋骨环抱器固定肋骨，重塑胸壁的结构及稳定性，同时记录与手术相关数据指标。结果 32 例患者均顺利完成胸腔探查+肋骨内固定手术，平均肋骨固定数 5.6 根（4~11 根），平均手术时间为126 min（86~180 min），术中平均出血量：130 mL（100~250 mL），术后平均拔管时间3 d（2~5 d），术后平均住院时间：8.5 d（6~15 d），术后平均随访 6 月，2 例患者出现胸壁慢性疼痛，无死亡及其他严重并发症患者。结论 胸腔镜辅助小切口治疗严重多发肋骨骨折安全、有效，它能使内固定手术更加微创化，促进患者快速康复。

关键词: 严重肋骨骨折, 胸腔镜, 肋骨内固定, 连枷胸